"That is happiness; to be disolved into something complete and great. When it comes to one, it comes as naturally as sleep." - Willa Cather

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Friday, 30 November 2007

Exercise and Running in Pregnancy: Point-Counterpoint

I have had a lot of fun looking up counterpoints for the feeble arguments that have been brought up on this blog and at the runango forum.

I would like to start off by reminding you that three qualified physicians (Running Doctor, Olga and myself) all believe my exercise and weight gain is perfectly healthy.

And now for the evidence:

Point #1.Running and 6 months pregnant is fine...not gaining any weight and still looking like you're maybe 3 months pregnant is not.

Couterpoints-Clearly if my size were appropriate for a 3 month pregnant woman, the midwives would be concerned. However yesterday my pubic bone to fundus measurement was within normal for 29 weeks.

-Though the effective size (ES) of the pregnant mothers who exercised under 30 minutes was greater than that of those who exercised between 30 and 60 minutes, the overall ES of the baby did not differ between the two groups.

ie, even though women who exercise more gain less weight, their babies' weights did not differ.(Winter, 2002, American Journal of Health Studies).

-A current meta-analysis of randomised trials of vigorous exercise during pregnancy did not find a clinically important effect of exercise on birth weight.

Point #2I had wanted to keep it [my pregnancy weight gain] to 30 pounds total... ended up with 42 I think...

Counterpoint-This woman gained MORE than recommended during pregnancy and no one dared give her a hard time, though what she did is KNOWN to be a huge risk for her child. Why isn't everyone jumping in and accusing her of not caring about her child? Because we're a society that condones excess weight gain despite the many health risks. Because poor her, "she couldn't help it", right? Well I think that's a bunch of BS. And here are some of the risks associated with excess weight gain during pregnancy:

Point #3She really really pisses me off. Seriously, it makes me want to weep for that poor child's life. Also, it makes me feel like crap. I could barely keep my kids in for 6 months and I did no running whatsoever and took it easy and this crazy b!tch runs 80 miles a week and doesn't eat and she'll probably go over her due date.

Counterpoint/Agreement-Yes, this poster is right. Premature births are most often caused by genetic factors or cervical defects, which are not affected by exercise. Bed rest, for example has never been shown to decrease premature births from cervical incompetence. And exercise itself has never been shown to cause premature births.

Points # 4 & #582 miles plus the cross training you did is not moderate. 3 hours is not moderate. 3 hours is more than a healthy non-pregnant elite does in a day!

You're right that they do not talk about any effects on PR's child. But that doesn't mean you can assume it's a healthy behavior like you're doing. You don't know, and you're willing to take a chance on the baby inside of you with something that is an unknown?

Counterpoint #1-31,000 women in their second trimester were involved in this study. Those who identified their physical activity level as vigorous were, on average, slightly older and more educated, and weighed less than women in the other two categories. However, there were no significant differences in the rates of low birth weight or fetal or neonatal death.

(Rose NC. Obstetrics & Gynecology. 78(6):1078-80, 1991 Dec.)

Counterpoint #2-There is limited evidence which suggests that exercise is related to shorter labour and is a useful treatment for gestational diabetes. Exercise is also associated with fewer symptoms and discomforts of pregnancy. This relationship is temporal in that exercise earlier in pregnancy is associated with fewer symptoms later in pregnancy. The lack of evidence for any harmful effects of exercise on pregnancy outcome indicates that, for healthy, well-nourished women, exercise during pregnancy is safe and subject to few restrictions. This conclusion is reflected in the revised recommendations of the American College of Obstetricians and Gynecologists.

(Sternfield B. Sports Medicine. 23(1):33-47, 1997 Jan.)

Point #6I love how she mentions back when were hunters and gatherers and women barely gained weight while pregnant. Yes there is a healthy comparisson for our modern age. How many women died in pregnancy and during childbirth in those days. And how many children died before age 5 if they survived the first few months of life.

Counterpoint-Please review the reasons for decreased infant and maternal mortality summarized by AtulGawande, MD below.By the fifties, owing in part to the tighter standards, and in part to the discovery of penicillin and other antibiotics, the risk of death for a mother had fallen more than ninety per cent, to just one in two thousand.

Around the world, virtually every child born in a hospital had an Apgar score recorded at one minute after birth and at five minutes after birth. It quickly became clear that a baby with a terrible Apgar score at one minute could often be resuscitated—with measures like oxygen and warming—to an excellent score at five minutes. Spinal and then epidural anesthesia were found to produce babies with better scores than general anesthesia. Neonatal intensive-care units sprang into existence. Prenatal ultrasound came into use to detect problems for deliveries in advance. Fetal heart monitors became standard. Over the years, hundreds of adjustments in care were made, resulting in what’s sometimes called “the obstetrics package.” And that package has produced dramatic results. In the United States today, a full-term baby dies in just one out of five hundred childbirths, and a mother dies in one in ten thousand. If the statistics of 1940 had persisted, fifteen thousand mothers would have died last year (instead of fewer than five hundred)—and a hundred and twenty thousand newborns (instead of one-sixth that number).(Gawande, The Score, Oct. 9th 2006, New Yorker)

And I will end with the following from the American Association of Family Practice: "Numerous case reports can be found of women who ran extensively throughout their pregnancies and who delivered healthy, normal birth weight infants. One example is Sue Olsen, ranked fourth nationally for 24-hour races. She ran a four-hour marathon when she was eight and one-half months pregnant. The following week she partly ran and partly walked a 24-hour race posting 62.9 miles.3 One week later she delivered a healthy infant. Although these reports lack comparison groups and are not generalizable, they lend support to the conclusion that healthy women with normal, uncomplicated pregnancies may exercise with few restrictions without adversely affecting their infants or themselves."

(Khanna, "The Effects of Exercise on Pregnancy" American Family Physician. April 1998.)

I can post a multitude of additional references for any of you who are interested.

CONCLUSION:

The weak and unresearched arguments posted on runango and on this blog recently are doing a disservice to pregnant women who deserve to know that exercise (even vigorous) along with its often-associated lower weight gain are safe and healthy in pregnancy for the mother and the baby.

9 comments:

Points # 4 & #582 miles plus the cross training you did is not moderate. 3 hours is not moderate. 3 hours is more than a healthy non-pregnant elite does in a day!

You're right that they do not talk about any effects on PR's child. But that doesn't mean you can assume it's a healthy behavior like you're doing. You don't know, and you're willing to take a chance on the baby inside of you with something that is an unknown?

Counterpoint #1-31,000 women in their second trimester responded to a questionnaire. Those who identified their physical activity level as vigorous were, on average, slightly older and more educated, and weighted less than women in the other two categories. However, there were no significant differences in the rates of low birth weight or fetal or neonatal death.

(Rose NC. Obstetrics & Gynecology. 78(6):1078-80, 1991 Dec.)

Counterpoint #2-There is limited evidence which suggests that exercise is related to shorter labour and is a useful treatment for gestational diabetes. Exercise is also associated with fewer symptoms and discomforts of pregnancy. This relationship is temporal in that exercise earlier in pregnancy is associated with fewer symptoms later in pregnancy. The lack of evidence for any harmful effects of exercise on pregnancy outcome indicates that, for healthy, well-nourished women, exercise during pregnancy is safe and subject to few restrictions. This conclusion is reflected in the revised recommendations of the American College of Obstetricians and Gynecologists.

So how many of those 31000 women were doing 3 hour runs, 82 miles a week of running in addition to 20 miles on the bike and whatever else you were doing? That is not moderate, it is not vigorous, it is extreme even for healthy non-pregnant people.

In this blog you repeatedly say how there is no evidence that it's bad for the baby. There is also no evidence that it is good for the baby. There are also no empirical studies done on this. Questionnaires are not empirical science.

You are selfish. In your desire not to be inconvenienced with a few extra pounds for a few months you are putting your baby at a higher risk. The instant you decided to have the baby your life should have changed to only do what is beneficial to that child, not what benefits you and may not harm the child.

Your continued rationalization of putting yourself in a higher place of importance than your child shows your selfishness and your lack of concern for anyone but you. You are clearly not ready to be a mother.

There is no science here, only anecdotes, and you're willing to risk your child with that. You're disgusting and I feel sorry that you're going to parent this child.

Just as an FYI, I was only able to run 1.5 of the 3 hours, the other 1.5 I walked. That's why it took me 3 hours for 12 miles. The pregnant body just won't allow women to do more than they can tolerate. Please see previous posts regarding empirical evidence for benefits to the baby (including improved blood flow to the brain and improved memory function). Running coach, you have absolutely NOTHING scientific to back up what you're saying. Please refrain from making lazy, unfounded comments on this blog. I have turned on comment moderation for the time because I am disgusted by your unscientific and unconstructive criticism. You have not read my blog and you obviously do not really care about the health me, my baby or of pregnant women, otherwise you would look more carefully at the research that has been done and what has been written in my blog.

"Just as an FYI, I was only able to run 1.5 of the 3 hours, the other 1.5 I walked. That's why it took me 3 hours for 12 miles. The pregnant body just won't allow women to do more than they can tolerate."

What are you willing to risk in trying to find your physical limits in pregnancy?

Girl, I love how much you dig out information for all of those who don't know where to look. The proclamation that what you do is unhealthy for non-pregnant woman is a bunch of bs - I wish all would do that much, the world would be a better place, not only healthier (with lower risks of diabetis and high blood pressure and related ilnesses), but also mentally (fewer arguments as the stress is guided in the direction of excercise, there is less time for fights and stupid ideas too).

Selfish - I have a conter-argument for that too. Because I truly believe one can not fully love other person (even if own baby) unless one loves him/herself. In fact, many marriages split exactly because Moms decide they only allowed to love their kids now and forget how they look, as well as the fact that tehir husbands need attention. Not good for the kids either.

SLG, I was also pretty concerned when I began reading your blog. When I face something REALLY different from what I am accustomed to, I am uncomfortable. You are super fit and frankly, most of our country is NOT. I've got a long way to go in fitness, myself. I decided I cannot criticize you since I am so busy attempting self improvement.

So sorry to hear that you have become injured! It sounds like you are slowly healing, though. I also had a wary piriformis a bit earlier in the season when I turned up the volume without turning up my time spent doing yoga. While my non-pregnant situation is quite different from yours, about a week of self-massage and focused work on hip-opening yoga poses with continued running yielded a healthy hip. Good luck to you on this!

While it's again sad that your blog and life have become the center of a seemingly unending slough of innappropriate commentary both here and in the Runango forum, I applaud you for standing up for yourself, supporting your position with empirical data, and seeking support from other medical professionals.

You appear a ridiculously beautiful, happy, pregnant athlete in your photos. I wish you continued success with your pregnancy and hurried hip healing! Thank you, again, for your willingness to question our culture's (sometimes questionable, outdated, and unheatlhy) norms and traditions and face the wrath of mainstream society who follow such norms only because everyone else does.

So as some of you may know, I love to run. But I have a love/hate relationship with running. I'm not obsessive about it. I certainly don't need to run every day...and do better when I cross train and swim or bike. I have definitely gotten burnt out from running, so I know I have to "pace" my training if I want to keep enjoying it.

Hello from Rude Skov

Photo by Stine Sophie Winckel

...

My name is Tracy. I am a physician scientist from the USA, living with my husband and two young boys in Denmark. I work as a post-doc fellow at Næstved Hospital. I have a scientific interest in vision loss, vision loss during exercise, exercise, running during pregnancy, MAF training as well as nutrition and health for athletes. I also have a love for music, physics, statistics, cycling, yoga, cross-country skiing, bla bla bal.

I was a member of Team USA at the IAU World Championships in Ultra Trail Running in 2013 in Wales. I am now training to run with Team Denmark at the IAU World Championships in Annency, France in May 2015.